Published by
Stanford Medicine

Category

Global Health

Global Health, Pediatrics, Public Safety, Research, Stanford News, Women's Health

Working to prevent sexual assaults in Kenya

Working to prevent sexual assaults in Kenya

Kenyan slumsThe little girl bounded up to us, wearing a filthy pink sweater, with a beaming smile on her face, and gave me a huge hug. Surprised at the reception, I hugged her back and swung her gently back and forth. She giggled and ran to hug my colleagues, then, hopping over an open sewer, darted into an alley that lead to her home. We followed as quickly as we could over the slippery mud, down one alleyway than another. Within a few minutes we reached her house, a 5’ by 10’ structure made of mud and wood, without windows, electricity, or locks. The girl, named Lianna*, lives here with her two year-old brother, who calls her “Mama”, as she is his primary caretaker. Their mother is a bartender and likely also a sex worker, and returns home only occasionally. The home is filthy, smells bad, and is without food or water. Yet this beautiful child, brimming with energy and intelligence, is proud to show it to us and to introduce us to her sibling.

Lianna is a resident of Korogocho, one of the poorest informal settlements (known to many as slums) in the Nairobi region of Kenya. Korogocho itself has about 52,000 residents, and it borders on other, larger informal settlements such as Dandora. Poverty and lack of sanitation are the norm in these communities, and crime is extremely high. Girls in these settlements may be especially vulnerable, with 18-25 percent of adolescent girls reporting being sexually assaulted each year, often by friends and relatives.

A multidisciplinary team at Stanford has been working in these communities on a sexual assault prevention project with two Kenyan non-governmental organizations (NGOs), Ujamaa and No Means No Worldwide (NMNW), for about two years. This past July, my colleague Mike Baiocchi, PhD, and I traveled to Kenya to meet the local NGO staff, become familiar with the communities they work in, and advance their research capacity.

Ujamaa, led by Jake Sinclair, MD, a pediatrician from John Muir Hospital, has been working in these and other settlements, including Kibera, Mathare, Huruma, Kariobangi, for more than 14 years, and has partnered with NMNW for several years. NMNW, led by Lee Paiva Sinclair, developed a curriculum to reduce sexual assault by teaching empowerment and self-defense, and works with Ujamaa to implement this curriculum in the slums. The Stanford team became involved in order to research the effectiveness of this intervention.

Continue Reading »

Behavioral Science, Global Health, Neuroscience, Stanford News

Stanford Rhodes Scholar heading to Oxford to study ways "the brain can go awry"

Stanford Rhodes Scholar heading to Oxford to study ways "the brain can go awry"

10515175_10152524157302002_5878205180193467577_o-001Undergraduate Emily Witt is one of two Stanford students selected to receive the prestigious Rhodes Scholarship to study abroad at Oxford next year; an announcement was made late last month.

Witt is a human biology major with a concentration in neuropathology, and she’s minoring in psychology. Her research experience thus far spans neuroscience, psychology, autoimmune pathology, and health in the developing world; and she says she’s interested in studying “any way that the brain or the nervous system can go awry.”

Witt, who plans to attend medical school after her scholarship tenure, works in the lab of  neurologist Lawrence Steinman, MD, PhD, which seeks to understand the pathogenesis of autoimmune diseases, particularly multiple sclerosis. She’s using the lab to conduct research for her honors thesis, which focuses on the mechanisms of vitamin D in multiple sclerosis. She’s also involved with the Center for Interdisciplinary Brain Sciences Research and has participated in various studies related to autism and social cognition.

After hearing about this honor, I reached out to Witt with some questions about her work and her future plans:

How did you become interested in this field?

I’m interested in MS for two reasons. On a personal level, I have seen the devastating impact of the disease first-hand as my uncle has the progressive form of MS. Watching his condition worsen, and seeing the impact it has had on his life and the life of my aunt and cousins, inspired me to research this horrible disorder.

On an intellectual level, I’m fascinated by the interaction between the immune system and the brain. I believe it’s an incredibly important area of research as the immune system is a contributing factor to numerous neurological diseases, from multiple sclerosis and autism to depression.

What makes Oxford a particularly appealing place for you to study? Who or what do you hope to work with there?

I’m interested in working with two neuroscientists who are experimental psychologists; they’re actually bridging the gap between experimental psychology and neuroscience, which are the two degrees I’m hoping to pursue while at Oxford. One is Elaine Fox, who researches cognitive biases, and the other is Catherine Harmer, [who studies the] pharmacological aspects of depression and how they affect cognitive biases, particularly with respect to depression and anxiety.

Are you interested in contextual understandings of disease or degeneration – its social roots? How does interdisciplinary work fit into your imagining of what you’re doing and would like to do?

That’s what my primary motivation going forward is: kind of connecting what I see in everyday life and how neurological [diseases] manifest and what I understand about them biologically. So what I’m really interested in is combining a fundamental understanding of psychology with clinical applications of neuroscience… Because I do think that… there’s still a wide gap between studying the brain on a molecular and cellular level, and studying it on a behavioral level.

Continue Reading »

Global Health, Infectious Disease, Microbiology, Public Health, Videos

'Tis the season for norovirus

'Tis the season for norovirus

The week before Thanksgiving, some kind of stomach bug, which I suspect was norovirus, spread like wildfire among my daughter’s daycare. Several of her classmates became sick and like dominos so did the parents, including us.

So I was more than sympathetic when I came across this video by John Green (of the vlogbrothers fame and author of “The Fault in Our Stars”) about his family’s Thanksgiving troubles with a norovirus infection that seems to have left no GI system untouched in their household.

Winter, from about November to April, is prime norovirus season. The treacherous illness, which as Green says “has amazing superpowers,” spreads when you come into contact with feces or vomit of an infected person. It can take less than a pinhead of virus particles to make this happen. Unlike other viruses, it can live on surfaces for surprising long periods, which is how a reusable grocery bag caused an outbreak among a girls soccer team in 2012. Plus, an infected person can continue to shed the virus for about three or four days after recovering. It’s possible to disinfect after an infection, but it’s a pretty intense job.

Given these characteristics it’s not surprising that this tiny virus (even by virus standards) causes about 20 million illnesses each year. Although for most people it’s a mild illness, for the very young,  old or those with compromised immune systems—it can be severe. About 56,000-71,000 people are hospitalized and 570-800 die from norovirus infections.

The situation is worse in developing countries, where, as Green points out, rehydration therapy is harder to come by for the most vulnerable. About 200,000 deaths are caused by norovirus infections in poor parts of the world.

In his typical funny and thoughtful style, Green talks about what lack of simple—and cheap—rehydration therapy means for many on our planet. It’s one more thing that it’s easy to take for granted, and one more thing to be thankful for.

Previously: Stanford pediatrician and others urge people to shun raw milk and products and Science weighs in on food safety and the three-second rule

Global Health, Infectious Disease, Stanford News

Back home from Liberia, Stanford physician continues to help in fight against Ebola

Back home from Liberia, Stanford physician continues to help in fight against Ebola

Colin Bucks - 560

Earlier this fall, we shared the story of Stanford physician Colin Bucks, MD, who, as a volunteer with the International Medical Corp, treated some 130 patients with Ebola in Liberia. Bucks is home now (he emerged from a 21-day home isolation on Nov. 14) but is still helping from afar. As reported by Inside Stanford Medicine:

Since his return to California, Bucks has been much in demand as a member of a small cadre of clinicians who have had direct experience with Ebola. He’s been working with health professionals at universities and nonprofits around the world who are doing research on new approaches to combating the disease, tracking trends in the epidemic and developing new designs for protective gear, which are cumbersome and stifling, he said.

“The heat stress is massive,” he said. “Your vision is limited. So anything we can do to improve PPE [personal protective equipment] will help improve patient care.”

During his quarantine, he said he did not have a moment of boredom; he was on the phone for 15 hours at a stretch consulting with health experts across the country on Ebola preparedness and on the needs in West Africa…

Previously: Stanford physician shares his story of treating Ebola patients in Liberia

Global Health, In the News, Public Health, Research, Science Policy

Gates Foundation makes bold moves toward open access publication of grantee research

Gates Foundation makes bold moves toward open access publication of grantee research

Bill and Melinda GatesLast week, the Gates Foundation announced that it will now require all grantees to make the results of their research publicly accessible immediately. Researchers will only be able to publish their research in scientific journals that make the published papers accessible via open access – which rules out publishing in many prominent journals such as Science and Nature.

Inside Higher Education detailed the new policy:

The sweeping open access policy, which signals the foundation’s full-throated approval for the public availability of research, will go into effect Jan. 1, 2015, and cover all new projects made possible with funding from the foundation. The foundation will ease grant recipients into the policy, allowing them to embargo their work for 12 months, but come 2017, “All publications shall be available immediately upon their publication, without any embargo period.”

“We believe that our new open access policy is very much in alignment with the open access movement which has gained momentum in recent years, championed by the NIH, PLoS, Research Councils UK, Wellcome Trust, the U.S. government and most recently the WHO,” a spokeswoman for the foundation said in an email. “The publishing world is changing rapidly as well, with many prestigious peer-reviewed journals adopting services to support open access. We believe that now is the right time to join the leading funding institutions by requiring the open access publication of our funded research.”

But the Gates Foundation policy goes further than other funding instutions. Once the papers are available publicly, they must be licensed so that others can use that data freely, even for commercial purposes. A news article in Nature explains the change:

The Gates Foundation’s policy has a second, more onerous twist which appears to put it directly in conflict with many non-OA journals now, rather than in 2017. Once made open, papers must be published under a license that legally allows unrestricted re-use — including for commercial purposes. This might include ‘mining’ the text with computer software to draw conclusions and mix it with other work, distributing translations of the text, or selling republished versions.  In the parlance of Creative Commons, a non-profit organization based in Mountain View, California, this is the CC-BY licence (where BY indicates that credit must be given to the author of the original work).

This demand goes further than any other funding agency has dared. The UK’s Wellcome Trust, for example, demands a CC-BY license when it is paying for a paper’s publication — but does not require it for the archived version of a manuscript published in a paywalled journal. Indeed, many researchers actively dislike the thought of allowing such liberal re-use of their work, surveys have suggested. But Gates Foundation spokeswoman Amy Enright says that “author-archived articles (even those made available after a 12-month delay) will need to be available after the 12 month period on terms and conditions equivalent to those in a CC-BY license.”

The Gates Foundation has funded approximately $32 billion in research since its inception in 2000 and funds about $900 million in global health funds annually. That’s a smaller impact than, say the U.S. National Institutes of Health, which funds about $30 billion in health research. But it does represent nearly 3,000 papers published in 2012 and 2013. Only 30 percent of those were published in open access journals.

Previously: Teen cancer researcher Jack Andraka discusses open access in science, stagnation in medicineExploring the “dark side of open access”, White House to highlight Stanford professors as “Champions of Change”Stanford neurosurgeon launches new open-source medical journal built on a crowdsourcing modelDiscussing the benefits of open access in science and How open access publishing benefits patients
Photo of Bill and Melinda Gates by Kjetil Ree

Emergency Medicine, Global Health, Stanford News, Videos

Improving global emergency medicine to save lives

Improving global emergency medicine to save lives

In July 2013, Stanford physician S. V. Mahadevan, MD, and colleagues conducted a study at the largest children’s hospital in Karachi, Pakistan to understand the kinds of medical emergencies that doctors treated at the facility. “What we found was astonishing,” he says in this Stanford+Connect video. “By fourteen days 10 percent of [the 1266 children enrolled in the study] were dead.” Mahadevan saw more children die during the one week he spent in the Pakistan hospital than in his entire 22-year-career in the United States.

Despite such dire statistics, there is hope. Mahadevan, founder of Stanford Emergency Medicine International, explains in the video how important early interventions can be made in the chain of survival to save thousands of lives in low-resource countries. Watch the full lecture to learn more about his efforts to establish Nepal’s first ambulance service, India’s first paramedic training program and his ongoing work to improve emergency care in Cambodia.

Previously: Stanford undergrad uncovers importance of traditional midwives in India, Providing medical, educational and technological tools in Zimbabwe and Saving lives with low-cost, global health solutions

Global Health, Pregnancy, Stanford News, Women's Health

Stanford undergrad uncovers importance of traditional midwives in India

Stanford undergrad uncovers importance of traditional midwives in India

IMG_0348Lara Mitra grew up taking regular vacations with her family in her ancestral home, the state of Gujarat in India, but those short trips barely prepared her for her first long-term stay. She says the 10 weeks she spent studying maternal delivery practices were eye opening in many ways. The work she did while there made a big enough impact that it landed her on a list of 15 impressive Stanford students featured in Business Insider last month.

During the summer between her sophomore and junior years, in 2012, Mitra secured a human rights summer fellowship through the Stanford McCoy Family Center for Ethics in Society. She worked with the Self-Employed Womens Association (SEWA), a large non-profit organization in India that helps women become economically self-sufficient, but also gathers other information about the well-being of women in the country. Mitra worked with SEWA officials to design a study looking at how often women in Gujarati villages used hospitals to deliver their newborns instead of delivering at home. Most home deliveries are carried out with the help of a dai, a village local who acts as a midwife but usually doesn’t have formal training.

Maternal mortality rates in India are still alarmingly high, so government agencies have started incentive programs such as offering free ambulance service to and from hospitals for laboring mothers and paying mothers to deliver in a hospital instead of at home, and pays dais to bring laboring mothers to hospitals. In light of all these incentives, it was unclear how often women were still delivering at home. And if they weren’t, Mitra says the question was “Are these dais, these midwife figures still useful? Is there still a job for them?” Mitra was excited to be doing the critical research and says, “It was the first time I wasn’t working in someone else’s lab and designed my own study.”

She found that women were in fact taking advantage of the government programs and delivering more often in hospitals, but the dais still played a critical role. In some situations, such as emergency deliveries, dias stepped in and delivered the children before mother and child were taken to the hospital for examination. Also, unlike in Western countries, husbands don’t play as intimate a role in the delivery, so the dai served as “birth coach” at the hospital, too. Dais also helped with prenatal and post-delivery care. Out of 70 women Mitra interviewed in 15 villages surrounding the Gujarati city of Ahmedabad, 69 said dais still served a useful role.

“More significantly, the trust women had in the dai couldn’t be replicated in doctors,” says Mitra. “Dais were part of a support system for women. The dai would do informal check-ups, and could tell if a C-section would be necessary.”

Continue Reading »

Events, Global Health, HIV/AIDS, LGBT, Medicine and Society

Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa

Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa

5015384107_517a74d0b5_zDuring the 1990s and early 2000s, HIV/AIDS pummeled through southern Africa killing thousands. Although the epidemic has abated somewhat, the disease is still spreading through certain communities, including the lesbian, gay, bisexual, transgender and intersex (LGBTI) population.

In Zimbabwe, where homosexuality is illegal and President Robert Mugabe has actively spoken out against the LGBTI community, health-care provider Caroline Maposphere works behind the scenes, trying to change the prevailing attitudes and laws without sparking a homophobic backlash like that in Uganda. Maposphere, who serves as a nurse, midwife, chaplain and gender advocate, will visit the Stanford campus this evening to discuss her efforts.

“She tells great stories about how you deal with the kind of social and community issues that lie around HIV prevention and gay and lesbian health issues in a very homophobic and resource-poor environment,” said David Katzenstein, MD, a Stanford infectious disease specialist who met Maposphere in 1992 while working on the Zimbabwe AIDS Prevention Project.

Preventing the spread of HIV in Zimbabwe isn’t as simple as handing out condoms or launching an education campaign, although those are key strategies, said Maposphere. The nation is poor, has few health-care facilities of any kind and LGBTI rights are non-existent. The traditional southern Africa culture view of homosexually, which was sometimes attributed to witchcraft, further complicates the issue.

“It’s very difficult to reach out with services to groups that are not coming out in the open,” Maposphere said. “We try to reach out and remove some of the barriers through discussion rather than being outright confrontational.”

Maposphere often encounters LGBTI individuals who feel they have been shunned by God and have been excluded from their churches in the predominantly Christian nation. In an effort to offer spiritual guidance as well as health care, she earned a college degree in theology and hopes to explore the religious aspects of her work while at Stanford.

In addition, Maposphere is planning to connect with gay-rights activists here and learn effective methods for countering homophobia in her native country. “I’m very hopeful that things will change,” she said.

The free discussion begins at 7:30 PM in the Vaden Education Center on the second floor of the health center on campus.

Previously: Remembering Kenyan statesman and Stanford medical school alumnus Njoroge Mungai, In poorest countries, increase in midwives could save lives of mothers and their babiesSex work in Uganda: Risky business and In Uganda, offering support for those born with indeterminate sex
Photo by Remi Kaupp

Global Health, Immunology, Pregnancy, Public Health, Stanford News, Technology

Stanford-developed smart phone blood-testing device wins international award

Stanford-developed smart phone blood-testing device wins international award

When I worked as an epidemiologist, one of my jobs was with a program that prevented perinatal hepatitis B infections. That’s when a woman with a chronic hepatitis B infection passes it on to her baby. Babies are more likely than almost any other group to develop chronic infections that can cause them years of health problems and will most likely cut their lives short.

In the U.S., most states have comprehensive testing programs to detect pregnant women with infections and strict protocols that require delivery hospitals to treat babies born to them with vaccination and antibodies to prevent infection with the virus. But a program like this requires a huge administrative and laboratory investment – and in many poverty-stricken parts of the world, this simply isn’t possible. In fact, in California, the vast majority of cases identified by the prenatal testing program are women who were born outside the United States, including many from Asia.

So when I heard the recent news that a team of four Stanford graduate students had won the Nokia Sensing XCHALLENGE, an international competition to for diagnostic devices, for a mobile test that could detect hepatitis B infections, I was pretty impressed and curious about how it could be implemented in those places. The competition is run by XPrize, the same group that has run several competitions for space exploration, and others for super-fuel efficient vehicles and ocean clean-up efforts.

The mobile version of the winning test was one of five awarded top prizes among 90 entrants. It was developed by engineering PhD candidates Daniel Bechstein, Jung-Rok Lee, Joohong Choi and Adi W. Gani, building on work previously done by Stanford professor of materials science and engineering Shan Wang, PhD, and Stanford immunologist  Paul Utz, MD. The device works because magnetic nanoparticles are grafted onto two biological markers: the hepatitis B virus and the antibody that our bodies make in response to the virus. Current tests for hepatitis B requires a full laboratory facility. A Stanford press release describes the device:

The students used a diagnostic strip that takes a finger prick of blood. The patient’s blood flows into a tiny chamber where it mixes with magnetic nanoparticles to form magnetically tagged biomarkers.

The test strip is inserted into a small magnetic detector… The smartphone is plugged into the detector, and its microprocessor helps to perform the test. It takes only a few minutes.

If the test finds the hepatitis B antigen in the blood, the patient is infected and needs treatment. For a newborn with an infected mother, the child needs both vaccination and antibody therapy.

Continue Reading »

Global Health, Pediatrics, Public Health, Public Safety, Research, Stanford News

Child-mortality gap narrows in developing countries

Child-mortality gap narrows in developing countries

MATERNAL & INFANT MORTALITY IN DEVELOPING COUNTRIESChild-mortality rates in developing countries are decreasing. In 2012, the United Nations estimated that worldwide mortality rates for children under the age of five have dropped by 47 percent since 1990. But what does this decline indicate about the mortality gap between the poorest and wealthiest families within those countries?

Stanford researcher Eran Bendavid, MD, answers this question in a study published today in Pediatrics. As our press release describes:

To compare wealth status and under-5 child-mortality within a country, Bendavid used data from the demographic and health surveys for 1.2 million women living in 929,224 households in 54 developing countries. The women provided information about their children’s survival status.

His findings showed that the child-mortality gap has narrowed between the poorest and wealthiest households in the majority of over 50 developing countries between 1995 and 2012.

The converging mortality gap was mostly driven by the fact that under-5 child-mortality rates declined the fastest among the poorest families. Bendavid said the finding supports international aid efforts that target communicable diseases such as malaria, diarrhea and respiratory illness that disproportionately affect the poorest families in developing countries. Davidson Gwatkin, a senior fellow at the Results for Development Institute who was not involved in the study, agreed saying:

Dr. Bendavid’s study is an important contribution to knowledge about child health improvements in the developing world … It makes a persuasive case that these improvements have often begun to benefit the poor even more than the better-off.

Yet not all the developing countries experienced this positive trend. In a quarter of the countries involved in the study, under-5 mortality inequality actually increased. Bendavid found a common theme among these countries: poor governance.

Bendavid noted in the release that his findings are important for making decisions about how to effectively promote health equality by prioritizing global health investments. He said:

We have the technologies, we have the means, we have the know-how to reduce child mortality dramatically … Even for such low-hanging fruit, however, implementation is not always easy. You have to have government that enables basic safety, and the ability to reach poor and rural communities that benefit from these kinds of programs.

Previously: Foreign health care aid delivers the goods, Foreign aid for health extends life, saves children, Stanford study finds, Stanford researchers say evidence doesn’t support claims that international aid is wasted and PEDFAR has saved lives — and not just from HIV/AIDS, Stanford study finds,
Photo by: United Nations Photo

Stanford Medicine Resources: